Provider Demographics
NPI:1013153824
Name:KUNTZ, KEESHA LEIGH (LPC #4250)
Entity Type:Individual
Prefix:MRS
First Name:KEESHA
Middle Name:LEIGH
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:LPC #4250
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E SILAS ST
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003
Mailing Address - Country:US
Mailing Address - Phone:918-337-6050
Mailing Address - Fax:918-337-6061
Practice Address - Street 1:417 E SILAS ST
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003
Practice Address - Country:US
Practice Address - Phone:918-337-6050
Practice Address - Fax:918-337-6061
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
OKLPC#4250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200316290AMedicaid